The pumpkins had already been scooped out and were arranged on the tables. The fall flowers were plentiful. And as some 10 nursing home residents looked on, the recreation director talked as she unwrapped each cellophane enclosure of bright yellow, deep gold, and orange-red mums. Then came the goldenrod and fern leaves as filler. The afternoon activity was to include some "hands on" involvement, which pleased our mother. When the residents had the outdoor planting activity, our mother was quite put out and vocal, “If I’m just going to sit here and watch, I may as well stay in bed and turn on my television,” she said.
This day she was looking forward to flower arranging because she likes doing things herself. She doesn't believe that a 93-year-old should be held "prisoner" without owning her own car and "coming and going" as she pleases. As such, she is pleased with activities in which she can bring her creations back to her room.
There are many ways to interpret recreation therapy. According to the American Medical Association, a partial definition says it is “a treatment service designed to restore, remediate and rehabilitate a person’s level of functioning and independence in life activities...." Recreational Therapist - American Medical Association
Watching vs doing
Certainly for those residents able to choose their own pumpkin, select flowers, and arrange and rearrange the fall blossoms --this was an independent function. But for those able to do little more than watch, I was itching for an active moment of "Gratitude or Remembrance Therapy."
The benefit and the glitch
For our mother, the value of recreating flower arrangements gave her a two-fold benefit. She made decisions regarding the colors. And she was able to engage in an activity that once gave her pleasure. Going to her own garden to snip flowers and bring them to the patio to arrange them brought out her artistic side.
This day she was able to relive the pleasure of floral arranging. Then we hit a glitch. She was getting tired and said, “Let’s take the pumpkin back to my room. I'm tired. I need to lay down. I'll finish later.”
Here was the problem. The pumpkins had to stay in the dining room – they were to be table decorations. She was agitated by this decision.
Nursing home agitation
Agitation comes quickly to nursing home residents. “I did all the work,“ she protested.
The recreation director explained again that these were for the dining room. Our mother was not happy. She asked again why she couldn't take the pumpkin flowers back to her room. Explanations can be an exercise in exasperation. It is so much easier to have an alternative to accomodate their wishes. Giving Alzheimer's Patients Their Way, Even Chocolate - The New York Times
The plastic pumpkin
For our mother, this required a quick fix moment. I told her that I thought my sister was bringing over a pumpkin for her and I would be right back. It occurred to me that I had given the nurses a plastic pumpkin filled with candy earlier. So I went to the desk and asked for the pumpkin back sans candy. When our mother saw it, she was thrilled.
"Where did that come from?" she asked.
I gave her the simple explanation. "Lois dropped it off for you. You can fill this with flowers and bring it back to your room and not have to worry about a fresh pumpkin going bad.”
Her answer and question: “That makes a lot of sense. Why do I have to go back to my room?”
"To take a nap."
"Why do I need a nap?" she asked. "Who said I was tired?"
With that she smiled, waved me off, and went back to filling her afternoon with pumpkin flowers.
Note: Sometimes just a few practical “fixes” can alleviate agitation in those whose minds are being hijacked by the disease. ( Will be a MetLife Journalist in Aging Fellow - among a group covering the upcoming conference for the Gerontological Society of America. Am anticipating new ideas for patients, caregivers, and policy makers.)
Have you read this? Empathy: Sister Simone, the Election, and Women
Copyright 2012 Rita Watson/ All Rights Reserved